Medicine of the Future in America

Skin metastasis from an occult esophageal adenocarcinoma: DISCUSSION (Part 1)

Cutaneous metastases are the 12th most frequent site for all tumour types . Skin infiltration may be the first sign of carcinoma, or it may accompany other symptoms or be noted during follow-up .The incidence of skin metastasis is 1% to 2.7% . The scalp is a relatively common site of cutaneous metastasis . Brownstein and Helwig reported that the scalp was the site in 4% of all skin metastases. Metastases to the skin from various internal organs are uncommon . It has been claimed that skin metastases tend to be close to the site of the primary tumour: chest in breast and lung cancers, abdominal wall in gastrointestinal tumours and lower back in renal cell carcinomas . Breast cancer is the most common origin of cutaneous metastasis in women, while lung cancer is the most common origin in men . Frequency of skin metastases from cancer of internal organs ranges from 0.7% to 9% . Skin metastases from primary gastric carcinoma are very uncommon ; the incidence varies from 0.04% in clinical series to 9% in autopsies . Skin metastases are classified macroscopically as nodular, inflammatory or sclerodermoid . They have been reported occasionally as multiple ulcerated and erysipeloid lesions , and as large nodular lesions involving parts of the neck and trunk . In some cases, skin metastases are multiple, firm, nonulcerated nodules . It should be noted that solitary lesions may be misdiagnosed as primary skin tumours. Buy Asthma Inhalers Online
Nodular lesions tend to appear suddenly . Inflammatory changes indicate rapid spread and deposition of cancer in the subepidermal lymph vessels . In the so-called carcinoma erysipeloides, tumour cells fill the lumina of dermal vessels . Cutaneous metastases of alimentary tract occur most commonly on the abdominal wall and can be the initial manifestation of a primary gastric tumour. Gastric adenocarcinomas spread chiefly by direct invasion and extension to regional lymph nodes and the liver . They may occasionally spread via lymphatic and blood vessels. Skin metastases develop most often after invasive procedures for diagnostic or therapeutic purposes as local skin metastasis or seedings , mainly in the epigastric and mammary regions. Because carcinomas spread preferentially by lymphatic vessels, gastrointestinal tumours may give rise to metastasis in the cervical lymph nodes. It was suggested that an aggressive clone of gastric adenocarcinoma cells metastasizes to cervical lymph nodes and subsequently invades the skin, imitating a primary skin lesion . It was also claimed that a clonal population of carcinoma cells exists, with a high affinity for the skin and a low affinity for other organs.

This entry was posted in Skin metastasis and tagged Cutaneous metastases, Esophageal adenocarcinoma, Histology, Oncology, Pathology.
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